Kratom is the leaf of a tree (Mitragyna speciosa) native to Southeast Asia. Preparations of it have long been used in that region to boost energy and relieve pain as well as to treat a range of other ailments. Its use has been growing in the U.S. in recent years for pain relief and also to help with withdrawal from opioids, but a study published in February 2019 has raised concerns about its safety.
The new research showed that in recent years, calls to poison control centers in the U.S. about kratom have increased dramatically, up from only 13 calls in 2011 to 682 by 2017. Of these, 32 percent resulted in admission to a hospital, and more than half involved serious medical consequences, including tachycardia (rapid heartbeat), agitation, high blood pressure, seizures, coma, kidney failure, and death. Of the 11 deaths reported, 9 involved people who had taken kratom with another drug: alcohol, diphenhydramine (Benadryl, an antihistamine and sedative), benzodiazepines (anti-anxiety drugs), fentanyl, or cocaine.
The study also found that 48 kratom exposures involved children age 12 and younger. Of those, 69 percent were under the ages of two, including seven newborns, five of whom experienced withdrawal symptoms. Study co-author Henry Spiller, director of the Central Ohio Poison Center, said that physicians need to educate pregnant women about the risks of using kratom during pregnancy and while breastfeeding.
Kratom is illegal in six states and the District of Columbia and is on the Drug Enforcement Administration’s list of drugs and chemicals of concern. In November 2017, FDA Commissioner Scott Gottlieb, M.D. warned against using kratom, particularly by people addicted to heroin and other opioids. He noted that the FDA has reports of kratom supplements being laced with opioids such as hydrocodone. Reportedly, kratom products are sold widely in smoke shops and elsewhere in the form of powders meant to be consumed as tea to help lessen the effects of opioid withdrawal. In 2017 the FDA reported 44 deaths related to kratom.
A bit of background: in September 2016 the U.S. Drug Enforcement Administration (DEA) put a proposed ban on the use of kratom on hold. The agency had been considering placing it in Schedule 1 of the Controlled Substances Act, which includes heroin, ecstasy and LSD. The postponement came in response to pressure from U.S. congressmen and senators, members of the public and representatives of the scientific community. The key issue was the effect a ban would have on ongoing research into whether kratom’s properties can lead to development of more effective – and less addictive – painkillers than morphine, Oxycontin and other opioids. Scientific evidence suggests that compounds in kratom are potent painkillers with less addictive potential than opioids, but there are no FDA-approved therapeutic uses of it.
No controlled clinical trials have been published on the safety and efficacy of kratom in humans for pain control or opioid withdrawal. And because there’s no doubt that some kratom products are adulterated – possibly with toxic drugs – it is impossible to know whether supplements containing kratom, or claiming to contain it, are safe.
Andrew Weil, M.D.
Henry A. Spiller et al, “Kratom exposures reported to United States poison control centers: 2011–2017.” Clinical Toxicology, February 20, 2019 doi.org/10.1080/15563650.2019.1569236
Walter C. Prozialeck, “Update on the Pharmacology and Legal Status of Kratom.” Journal of the American Osteopathic Association, December 2016, doi:10.7556/jaoa.2016.156